A man complained about the care provided by his general
practitioner, who failed to initiate timely investigations, leading
to a delayed diagnosis of bladder cancer.

The 48-year-old man consulted his GP on three occasions over ten
months complaining of blood in his urine (macroscopic haematuria)
with no accompanying pain. At the first and second consultations,
the GP put this down to a urine infection and prescribed an
antibiotic. The GP did not order any investigations, and did
not sufficiently warn the man that the haematuria could indicate
serious pathology and that he should therefore be attentive to any
recurrence.

When the man presented to the GP a third time with the same
complaint, the GP ordered investigations and referred the man to a
urologist. An ultrasound revealed that the man had a large bladder
tumour, which was subsequently treated surgically.

It was held that when the man first presented with painless
macroscopic haematuria, the GP should have ordered laboratory tests
to exclude infection. If infection was absent, secondary
investigations should have been carried out. The need for action to
be taken to investigate the haematuria was even greater when the
man presented for a second time, six months later, with the same
concerns. The GP's failure to investigate the haematuria or refer
him to a specialist at the first and second consultations was a
breach of Right 4(1).